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The Telemedicine Question: Is e-Health Ethical and Effective?

By Rami Hashish, PHD, DPT / February 02, 2016

Telemedicine is a burgeoning, integral component of health care that's supported by the American Medical Association. It is formally defined by the American Telemedicine Association as "the use of medical information exchanged from one site to another via electronic communications" through "a growing variety of applications and services using two-way video, email, smartphones, wireless tools, and other forms of telecommunications technology."

Consider the following example: You sit down to enjoy a meal with your parents when, all of a sudden, your mother starts complaining of chest pain. To be on the safe side, you decide to take her to the nearest hospital. After a series of tests, the doctor believes she'll be just fine; however, he'd like to keep a close eye on her, so before she's discharged, your mother is outfitted with a mobile monitoring system that tracks her vitals and heart rhythm. This allows the hospital to track her health in real time and receive alerts in the case of any abnormalities. Rather than following up directly at a clinic, your mother will confer with her doctor over video chat.

Opening an Ethical Can of Worms

The whole concept sure seems convenient (and futuristic), doesn't it? Despite its promise, there are also significant ethical concerns that arise, not least of which are the need for confidentiality of patient information and the doctor's specific responsibilities and liabilities. These policies are fleshed out in traditional health care, but this isn't the case for telehealth.

The clinical liabilities and privacy of health records notwithstanding, a larger ethical dilemma comes down to dollars and cents. Although telehealth services started as a way to conveniently deliver health care and to provide care to individuals in less-accessible areas, insurance companies are hinting that it may be a good cost-cutting measure for everyone.

Worththe Hoopla?

Theoretically, in order to assuage these ethical concerns, delivery of care through the use of information technologies would have to prove equal or more effective than the alternative. Some research is starting to shed further light on the matter. For instance, a recent review paper showed that telemedicine was effective in treating and managing 3,082 patients with congestive heart failure, and patient quality of life and satisfaction were found to be equal or better than traditional care.

Similar results were reported by Telemedicine and e-Health, which examined a telehealth program's effectiveness in managing 17,025 patients with chronic conditions. Their analysis revealed "a 25 percent reduction in numbers of bed days of care, 19 percent reduction in numbers of hospital admissions, and a mean satisfaction score rating of 86 percent after enrollment into" a home telehealth program. Moreover, the cost of the program was $1,600 per patient per annum -- an amount substantially less than noninstitutional care programs.

Judging by these results, administering care through the use of telecommunication is effective from both a clinical and cost perspective. However, considering that the practice is in its infancy, the long-term risks of an excessive reliance on technology for interacting with and treating patients are unknown and may be to the detriment of clinician-patient relationships. And because so much is unknown regarding this delivery method, it is unclear whether it will continue to prove effective or whether clinicians will use it excessively -- or even recklessly.

A recent review paper highlights the widespread current lack of understanding of telemedicine, stating that experts "point to a continuing need for larger studies ... and more focus on patients' perspectives, economic analyses, and telemedicine innovations as complex processes and ongoing collaborative achievements." Clearly, a new age of health care is upon us. And while it may prove convenient, only time will tell whether it will prove effective -- and ethical.

Dr. Rami Hashish achieved his doctorate of physical therapy from the University of Washington School of Medicine and holds a doctorate in biokinesiology from the University of Southern California. Following his Ph.D. work, Dr. Hashish cofounded a footwear technology startup, JavanScience, which develops customizable footwear to help relieve and prevent foot and leg problems. Dr. Hashish is also active in the clinic, serving as the director of physical therapy for Regenerative Medicine - Pacific Pain & Wellness Group, at Urban Med in downtown Los Angeles.